Before completing this section please refer to previous immunisation records/annual reviews

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1 Annual Review Name DOB Hospital No CHI number Date Sections 1. Immunisation 2. Metabolic 3. Growth & Puberty 4. Neurodevelopment and Education 5. Disclosure and Adherence

2 Immunisation Section Before completing this section please refer to previous immunisation records/annual reviews Varicella immunisation (over 1 year of age) Clinical history of VZV If N VZV IgG present? /not checked Date / / If not checked then please check If N then organise for VZV immunisation (dependant on current CD4 count discuss with responsible physician) Hepatitis B immunisation (over 10 ys of age unless risk of acquisition prior to this age) Has a course of hepatitis B immunisations been given? If Y Has HepBsAb level been checked Level IU/ml /not checked Date / / If not checked then please check and discuss level with responsible physician. If N If level <10 IU/ml then please check HepBsAg and HepBcoreAb If both negative organise full course of repeat Hepatitis B immunisation. If level IU/ml then organise for a single booster Hepatitis B immunisation If level > 100 iu/ml then no further action required Please check HepBsAg & HepBcoreAb (and Hep C Ab) and if no evidence of Hep B infection then a course of Hepatitis B vaccines to be given and HepBsAb level checked thereafter SPAIIN Guidance Annaul Review May 2012 Page 2 of 12

3 Immunisation Section If more than 5 years since primary course of Hepatitis B immunisation has a single booster (1 time only) been given? Date of booster / / If N then please organise. Influenza Annual influenza immunisation If N then please organise through GP Pneumococcal If the child did not receive immunisations as per the UK immunisation schedule did he/she receive prevnar 13? If no & age < 5 y then please arrange for prevnar 13 immunisation x2 (1 month apart) via GP Prevnar 13 immunisation (1 st ) Date / / Prevnar 13 immunisation (2 nd ) Date / / SPAIIN Guidance Annaul Review May 2012 Page 3 of 12

4 Metabolic Section Bone health and vitamin D status Once yearly Ca, phosphate, 25 hydroxy vitamin D, parathyroid hormone, alkaline phosphatise, urea, electrolytes and creatinine checked in autumn winter Results Ca Po4 25OHVitD PTH AlP Creat Date / / If vitamin D < 25nmol/l 1 6mths 6m 12y 12y 18y 3000units/d for 12 weeks 6000units/d for 12 weeks 9000units/d for 12 weeks If vitamin D nmol/l 1 6mths 6m 12y 12y 18y 3000units/d for 6 weeks 6000units/d for 6 weeks 9000units/d for 6 weeks If vitamin D >50 nmol/l and child < 5 ys then offer either Abidec or Dalivit supplementation Ergocalciferol (D2) and colecalciferol (D3)can be used interchangeably for treatment. Please note local availability of Vit D preparations.

5 Metabolic Section Lipids and vascular health Once yearly cholesterol, HDL, LDL and triglycerides (non fasting) Total cholesterol LDL cholesterol Date / / If cholesterol >4.4, or LDL cholesterol >2.9 refer to dietician and arrange repeat testing (fasting) within 6 mths If cholesterol > 5.2, or LDL chol > 3.4 obtain fasting measurement and discuss with responsible clinician Smoking Lipodystrophy b1) Body fat changes None Mild Moderate Severe b2) Investigations undertaken Yes No i) Fat accumulation Neck Limb/waist etc. measurement Breast Skinfold thickness Abdomen DEXA scan (measure body fat) ii) Lipoatrophy Face DEXA scan (measure bone density) Arms MRI scan Legs CT scan Prominent veins Body Impedance Analysis If any signs of lipodystrophy discuss with responsible clinician SPAIIN Guidance Annaul Review May 2012 Page 5 of 12

6 Growth & Puberty Section Growth Ht Wt (Plot on growth chart within notes/clinical audit system) BMI (height (cms)/weight (kg) 2 If BMI > 25 then refer to dietician/local weight loss support program (e.g. ACES) If height or weight below 2 nd centile or falling through centiles then discuss with responsible clinician Puberty staged from 12 ys of age Boys development of external genitalia Stage 1: Prepubertal Stage 2: Stage 3: Stage 4: Stage 5: Enlargement of scrotum and testes; scrotum skin reddens and changes in texture Enlargement of penis (length at first); further growth of testes Increased size of penis with growth in breadth and development of glans; testes and scrotum larger, scrotum skin darker Adult genitalia Girls breast development Stage 1: Prepubertal Stage 2: Stage 3: Stage 4: Stage 5: Breast bud stage with elevation of breast and papilla; enlargement of areola Further enlargement of breast and areola; no separation of their contour Areola and papilla form a secondary mound above level of breast Mature stage: projection of papilla only, related to recession of areola SPAIIN Guidance Annaul Review May 2012 Page 6 of 12

7 Growth & Puberty Section Boys and girls pubic hair Stage 1: Prepubertal (can see velus hair similar to abdominal wall) Stage 2: Stage 3: Stage 4: Stage 5: Sparse growth of long, slightly pigmented hair, straight or curled, at base of penis or along labia Darker, coarser and more curled hair, spreading sparsely over junction of pubes Hair adult in type, but covering smaller area than in adult; no spread to medial surface of thighs Adult in type and quantity, with horizontal distribution ("feminine") Indications for referral to endocrinology: no signs of secondary sexual characteristics in girls aged 13 and boys aged 14 or more practically if the patient is concerned, particularly if there is no family history of pubertal delay SPAIIN Guidance Annaul Review May 2012 Page 7 of 12

8 Neurodevelopment and Education Section Does the child s carer have specific concerns in the following areas? Mobility Vision Hearing Speech Understanding School progress Behaviour Routines Memory Concentration Activity/energy levels Emotional Specific concern Educational history School attends at present: Age started school: No of previous schools: Any concerns noted about progress at school at present or earlier: Any other concerns (attendance, behaviour, friendships etc.) Any additional help child receives in school: None / school action / school action plus / statement Describe School report available Yes/No Very poor OK Very good Carer rating of child s progress at school Child rating of school progress SPAIIN Guidance Annaul Review May 2012 Page 8 of 12

9 Disclosure and Adherence Section Level of child s knowledge: None or little Partial Full Date Name of parent/carer present: Standard process: list interventions or approaches agreed Description of plan: 1. Y N 2. Y N 3. Y N 4. Y N Extra support (e.g. Psychologist) 5. Y N 6. Y N 7. Naming conversation: Date: Child s response & comments : Persons present: Achieved Y N Y N Y N Y N Y N Y N If the child/adolescent is aware of their diagnosis and on/about to start therapy does the child/adolescent understand the concepts of; viral suppression rather than cure recovery of the immune system and potential for long and healthy life life long adherence to drugs viral resistance and its relationship to adherence potential side effects of current regimen SPAIIN Guidance Annaul Review May 2012 Page 9 of 12

10 Disclosure and Adherence Section For those on HAART Has the child/adolescent had a repeatedly undetectable viral load over the last year (6 months after starting current regimen of HAART)? Who is responsible for administering the medication? Child/adolescent Parent Other (specify ) Does the child/adolescent/carer use a dosette box? Who loads the dosette box? Child/adolescent Parent Other (specify ) Ask the person responsible for administering the medication (i.e. child/adolescent or carer) to list the current regimen Drug Freq Amount tabs/mls Drug Freq Amount tabs/mls Drug Freq Amount tabs/mls Drug Freq Amount tabs/mls At what times of day does the child/adolescent take medications Does the child/adolescent take medications with food? SPAIIN Guidance Annaul Review May 2012 Page 10 of 12

11 Disclosure and Adherence Section If the child is > 13ys of age and the parent takes full responsibility for administering the medication, discuss with the parent when they expect the adolescent to start to take responsibility for the medication. Discuss strategies for gradual handover of responsibility and continuing support from parent How many doses of medicine have been missed over the last 3 months? doses Does the child/adolescent /carer have a plan for what to do when medications are missed or if they are away from home and do not want to disclose their medications? Is the child/adolescent /carer aware of or have concerns regarding any potential side effects of medication? SPAIIN Guidance Annaul Review May 2012 Page 11 of 12

12 Sexual Health Section Sexual Health Please note that this will be covered by the sexual health advisor attached to the adolescent clinic and documented in that circumstance SPAIIN Guidance Annaul Review May 2012 Page 12 of 12